- Cognizant (Albany, NY)
- …to determine if the service rendered was medically appropriate and criteria compliance . + Analyze claim and line-item edits, including warning messages, to determine ... UB/institutional (CMS-1450) and/or professional (CMS 1500) claims. + Knowledge of Medicare /Medicaid payment and coverage guidelines and regulations. + Must be able… more
- Premier Medical Group of the Hudson Valley (Poughkeepsie, NY)
- …to detail, and exercise professional work ethics. + Familiarity with applicable Medicare and Medicaid programs preferred. + Understanding of HIPAA, Privacy, Safety, ... and Compliance guidelines. + Knowledge of Transition of Care procedures and processes preferred. + Intermediate understanding and ability to navigate a database… more
- Molina Healthcare (Syracuse, NY)
- …and supervision of daily functional operations to insure compliance to contract requirements. **Knowledge/Skills/Abilities** * Oversees budget responsibilities ... type management responsibility. 5 years progressive experience supporting a Medicaid,. Medicare and Marketplace or large claims processing environment with… more
- Catholic Health Services (Roslyn, NY)
- …on Long Island to receive a five-star rating from the Centers for Medicare & Medicaid Services for consistently high patient satisfaction scores. Job Details An ... in quality improvement initiatives to enhance patient care and safety. Ensure compliance with state and federal regulations, as well as practice-specific policies… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and community events. Essential Accountabilities: Level I * Educates Medicaid, Medicare , and Commercial members on healthcare benefits, and community resources ... needs, and other high-risk issues. * Conducts targeted phone calls for compliance , HEDIS initiatives and health risk assessments. * Collaborate with Case Management… more
- Elderwood (North Creek, NY)
- …Elderwood at North Creek has earned a 4-star rating from the Centers for Medicare and Medicaid Services (CMS)-exceeding both the New York state average (3.33) and ... Nurse of any changes in residents' conditions or needs + Follow and ensure compliance with each resident's Profile of Care and plan of care + Respond immediately… more
- Humana (Albany, NY)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to… more
- Humana (Albany, NY)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to… more
- Humana (Albany, NY)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to… more
- SUNY Upstate Medical University (Syracuse, NY)
- …code radiology procedures using ICD-10, CPT, and HCPCS codes. + Ensure compliance with current healthcare regulations and payer requirements. + Prepare and submit ... medical terminology and anatomy. + Strong understanding of insurance guidelines, including Medicare and Medicaid. + Proficient in EPIC systems for billing and coding… more